General Update #274 - Monday, January 11, 2021

8:09 a.m. - Jess arrived to farmhouse to provide morning care for Joyce, finding Joyce in the bathroom. Urinary incontinence, Joyce had taken off her diaper and diaper pad insert. Remainder of urine passed. Jess assisted Joyce with cleanup. Hemorrhoidal cream applied. Joyce returned to recliner by 8:19 a.m.

8:23 a.m. - BP 170/83, pulse 77. BGL @154, 

Joyce stated she was thirsty and was given a large glass of water. Jess was uncertain if the upcoming blood draw to be done by the Kindred staff this morning at the farmhouse was supposed to be one that required a fast so she did not feed Joyce food at this point just in case. 

Joyce did not know who Jess was today but knew Jess' voice. Jess informed Joyce who Jess was and Joyce appeared to acknowledge.

9:08 a.m. - Debra (Kindred) arrived to farmhouse to take a blood draw from Joyce and recertify Joyce for continued in-home visits from Kindred. 

Losartan added to Joyce's records (again). When Joyce was asked by Debra if she has headaches, Joyce replied "sometimes." Joyce reported no body pain. Joyce noted to be walking well while using walker. Jess provided Debra with an update on Joyce's condition for the past week (being unstable, extreme fatigue, incoherence, confusion, etc.).

9:27 a.m. - Blood pressure medication given to Joyce with water.

Jess and Debra talked about Joyce's constipation and stool color. "Dark" stools most likely the result of the iron supplement Joyce is being administered to counteract her anemia. If stools are "shiny black" then there should be concern for internal bleeding.

Debra is ordering continued visits once per week from Kindred for Joyce as family care providers are doing such a good job caring for Joyce at present. If family care providers determine that Joyce may need additional visits from Kindred staff during a week then Dr. Collins can order a visit increase.

2 ampules of blood were drawn from Joyce by Debra but Joyce's veins kept closing. Debra had to poke Joyce 3 times to collect enough blood (and Debra uncertain if enough blood was collected to meet testing minimums - may have to return to try again later if laboratory says amount collected is insufficient).

10:20 a.m. - Debra departed farmhouse.

10:25 a.m. - Bathroom trip. Urinary incontinence. Diaper and diaper pad insert replaced. Skirt replaced. Remainder of urine passed. Urine strong in odor but light in color.

10:26 a.m. - Debra (Kindred) called Dusty's cellphone to confirm that the blood dropped at lab was sufficient and she would not need to return to farmhouse to try and draw more blood from Joyce - apparently there was difficulty in getting enough blood from Joyce to fill ampules, Joyce had to be poked twice to get enough blood to flow.

10:35 a.m. - Remainder of morning medication taken with nutritional shake.

10:40 a.m. - Breakfast (1 slice whole wheat bread with egg and whole banana). Breakfast finished by 11:20 a.m.

12:20 p.m. - Dusty arrived to farmhouse, found Joyce sitting upright and asleep in her recliner. Joyce's oxygen line was not in place. BP 115/68, pulse 76. BGL @ 178. Joyce informed Dusty she was hungry and wanted to eat after she roused herself.

12:25 p.m. - Lunch (leftover omelet, 1/2 slice toast with butter, 1/2 banana). 1 cup cranberry juice with 2 Tylenol. Lunch finished by 1:40 p.m., Joyce ate very slowly and kept falling asleep while trying to eat.

1:45 p.m. - Bathroom trip declined. Napping began.

2 p.m. - Bathroom trip declined. Napping resumed.

2:30 p.m. - Bathroom trip declined. Napping resumed.

3 p.m. - Bathroom trip declined. Extremely difficult to wake Joyce up, even with physical shaking of her body by Dusty. Joyce extremely incoherent and had difficulty processing spoken words. Did not know who Dusty was or what time it was (Joyce convinced that it was 3 a.m. and was unhappy at being woken "at such an hour by you nurses").

3:07 p.m. - Bathroom trip, Joyce able to walk under her own power but was very unsteady and slow. Urinary incontinence, early bladder release. Bathroom sanitized. New diaper and diaper pad insert. Joyce babbled about needing to get Dusty ready for school (she was circa 1995 in her dialogue, Dusty went from being recognized to unknown at several points in the conversation). Joyce had extreme difficulty in processing conversation, interrogatives, or following verbal instructions. Joyce became hostile at one point before returning to a confused state. Joyce declined hemorrhoidal cream application, disregarding Dusty's directions (possibly to avoid being put into shower) with one-track mind. Returned to recliner under her own power with difficulty by 3:20 p.m.

3:30 p.m. - Joyce stretched out to nap in recliner. Dusty departed farmhouse to return to campus office. 

4:08 p.m. - Wendy (Dr. Collins' nurse at Moscow Medical) called Dusty with results of blood draw taken earlier this morning. No significant abnormalities (blood counts, etc. all within acceptable ranges). Dr. Collins recommends discontinuing use of nabumetone and aricept for now as they may exacerbate dementia. 

Dusty clarified that Joyce was not taking aricept as part of current medication plan. Wendy confirmed that she mis-read Joyce's prescription chart and confirmed Joyce is no longer on aricept (used to treat dementia, an enzyme blocker that works by restoring the balance of natural neurotransmitters in the brain).

Wendy confirmed that nabumetone and aricept can actually make dementia issues worse in patients "who are further advanced with Alzheimer's" disease. If family caregivers see that Joyce's overall condition continues to decline after nabumetone is stopped, an evaluation on Joyce should be performed. Wendy says she spoke with Carol last Friday (1/8) via phone call in regard to options for this process and informed Carol that it could either be a scheduled clinic visit or impromptu ER visit depending on situation.  

Carol also used the term "black" to describe Joyce's stool on Friday to Wendy - Wendy clarified the reason for the blood draw today was because of concern over the colon cancer vs. iron supplement plus increased confusion in Joyce. The blood draw cleared it up and the darker stool is most likely result of the iron supplement being taken for Joyce's anemia. "Shiny black" stool is what to watch out for in bowel movements to indicate internal bleeding. 

If Joyce deteriorates more after stopping the nabumetone (currently given to Joyce for arthritis pain relief) then family should contact Moscow Medical to schedule the clinical visit for assessment or take Joyce to the ER for evaluation and assessment. 

5:02 p.m. - Dusty notified Carol not to give Joyce evening nabumetone dosage. Dusty notified Jess to remove morning nabumetone dosage from Joyce's regimen as well.